Featured Research

Polysomnography for sleep-disordered breathing prior to tonsillectomy in children

Date:

June 15, 2011

Source:

American Academy of Otolaryngology - Head and Neck Surgery

Summary:

A multidisciplinary clinical practice guideline, "Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children" will be published as a supplement to the July issue of Otolaryngology -- Head and Neck Surgery. This guideline provides otolaryngologists with evidence-based recommendations for using polysomnography in assessing children, aged 2 to 18 years, with sleep-disordered breathing and who are candidates for tonsillectomy, with or without adenoidectomy.

Share This

A multidisciplinary clinical practice guideline, "Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children" will be published as a supplement to the July issue of Otolaryngology -- Head and Neck Surgery. This guideline provides otolaryngologists with evidence-based recommendations for using polysomnography in assessing children, aged 2 to 18 years, with sleep-disordered breathing and who are candidates for tonsillectomy, with or without adenoidectomy.

Related Articles

Polysomnography (PSG), commonly referred to as a sleep study, is presently the gold standard for diagnosing and quantifying sleep-disordered breathing (SDB) in children. SDB affects approximately 12% of children with manifestations ranging from simple snoring to potentially serious conditions, including sleep apnea. SDB is also the most common indication for tonsillectomy with or without adenoidectomy in the United States. Since more than 530,000 tonsillectomies are performed annually on children younger than the age of 15, primarily for SDB, clear and actionable guidance on optimal use of PSG is strongly needed.

"Less than 10% of children get a sleep study before tonsillectomy," notes Richard M. Rosenfeld, MD, MPH, guideline author and consultant. "The polysomnography guideline will empower doctors and parents to get the right test for the right reasons, leading to safer surgery and better outcomes for children with tonsils that block their breathing while asleep."

The primary purpose of this guideline is to improve referral patterns for polysomnography among these patients. In creating this guideline, the American Academy of Otolaryngology -- Head and Neck Surgery Foundation selected a panel representing the fields of anesthesiology, pulmonology medicine, otolaryngology-head and neck surgery, pediatrics, and sleep medicine.

Polysomnography (PSG), also called a sleep study, is the best test for diagnosing sleep-disordered breathing, which can include snoring, gasping, choking episodes, and breath-holding (apnea).

PSG is like getting an EKG but while asleep: children stay overnight, with their parent, in a special sleep lab with stick-on electrodes that record oxygen levels, respiratory effort, heart rate, and other factors.

PSG is important because it helps doctors and families make evidence-based decisions about tonsillectomy and whether the surgery can be ambulatory (out-patient) or requires an overnight hospital stay.

Why is the Polysomnography Guideline newsworthy?

First -- and only -- national, evidence-based guideline on PSG prior to tonsillectomy in children.

Sleep-disordered breathing affects 12% of children and is the #1 reason why over 530,000 tonsillectomies are performed annually on children under age 15 years in the United States.

The primary purpose of this guideline is to provide evidence-based recommendations for PSG prior to tonsillectomy in children between 2 and 18 years with sleep-disordered breathing as the reason for surgery.

Although the guideline was developed with other specialties, the intent is to provide guidance for ENT (ear, nose, and throat) doctors, also called otolaryngologists -- head and neck surgeons.

Specialties that contributed to the guideline included pediatrics, sleep medicine, pediatric anesthesiology, pediatric pulmonology, and otolaryngology-head and neck surgery.

What are the newsworthy points made in the Guideline?

PSG should be obtained before tonsillectomy in children with sleep-disordered breathing who have conditions that increase their risk of complications from surgery or anesthesia, including obesity, Down syndrome, craniofacial abnormalities (e.g., cleft palate), neuromuscular disorders (e.g., muscular dystrophy), sickle cell disease, or mucopolysaccharidoses (metabolic problems in digesting sugars).

Doctors should encourage otherwise healthy children (without any of the conditions in #1) to have PSG when either the need for tonsillectomy is uncertain (e.g., differing opinions or observations among parents, family members, primary care doctors, and specialists) or when size of the tonsils is smaller than what would be expected from the severity of snoring or sleep disturbance.

When a child does get PSG before tonsillectomy, the surgeon should communicate the test results to the anesthesiologist before surgery begins in case the anesthesia approach needs to be modified.

Children should be admitted to the hospital for overnight monitoring after tonsillectomy if they are under 3 years of age, because they may require oxygen or breathing assistance after surgery.

Children should be admitted to the hospital for overnight monitoring after tonsillectomy if PSG indicates they have severe obstructive sleep apnea, which is a type of sleep-disordered breathing in which the child's oxygen levels drop below 80%, there are 10 or more breathing obstructions (weak breaths or apneas lasting 10 seconds or longer) every hour, or both.

When PSG is indicated to assess sleep-disordered breathing prior to tonsillectomy, doctors should obtain laboratory-based PSG (an overnight study attended by a technician in a sleep laboratory), not home-based PSG (with a portable, unattended monitoring device), because more is known about the accuracy and interpretation of laboratory-based testing.

American Academy of Otolaryngology - Head and Neck Surgery. "Polysomnography for sleep-disordered breathing prior to tonsillectomy in children." ScienceDaily. ScienceDaily, 15 June 2011. <www.sciencedaily.com/releases/2011/06/110615014626.htm>.

American Academy of Otolaryngology - Head and Neck Surgery. (2011, June 15). Polysomnography for sleep-disordered breathing prior to tonsillectomy in children. ScienceDaily. Retrieved March 31, 2015 from www.sciencedaily.com/releases/2011/06/110615014626.htm

American Academy of Otolaryngology - Head and Neck Surgery. "Polysomnography for sleep-disordered breathing prior to tonsillectomy in children." ScienceDaily. www.sciencedaily.com/releases/2011/06/110615014626.htm (accessed March 31, 2015).

More From ScienceDaily

More Health & Medicine News

Featured Research

Mar. 31, 2015  In addition to their physical injuries, women who are victims of domestic violence are also at a greater risk of mental health problems such as depression and psychotic symptoms. "We studied the ... full story

Mar. 31, 2015  New research has scientists re-thinking how a lethal fungus grows and kills immune cells. The study hints at a new approach to therapy for Candida albicans, one of the most common causes of ... full story

Mar. 31, 2015  As the United States faces transplant waiting lists that continue to grow longer over time, there is increasing debate about the proper way to incentivize living donations. Due to organ shortages, ... full story

Mar. 31, 2015  The most virulent strains of Streptococcus suis, the leading cause of bacterial meningitis in adult humans in parts of southeast Asia and in pigs around the world, are likely to have evolved and ... full story

Mar. 31, 2015  A unique pattern of immune molecules in the cerebrospinal fluid of people with myalgic encephalomyelitis/chronic fatigue syndrome have been discovered, providing insights into the basis for cognitive ... full story

Mar. 31, 2015  Children who get a taste of their parents' wine now and then may be more likely than their peers to start drinking by high school, according to a new report. The findings are based on 561 Rhode ... full story

Mar. 31, 2015  Scientists have uncovered the unique mechanism of a powerful natural product with wide-ranging antifungal, antibacterial, anti-malaria and anti-cancer effects. The work sheds light on the natural ... full story

Mar. 30, 2015  Neuroscientists are taking inspiration from natural motor control to design new prosthetic devices that can better replace limb function. Researchers have tested a range of brain-controlled devices ... full story

Mar. 30, 2015  Scientists have found the genetic signature of enterovirus D68 in half of the California and Colorado children diagnosed with acute flaccid myelitis -- sudden, unexplained muscle weakness and ... full story

Mar. 30, 2015  The first study to investigate the relationship between eating fruit and vegetables containing pesticide residues and the quality of men's semen has shown a link with lower sperm counts and ... full story

Featured Videos

Solitair Device Aims to Takes Guesswork out of Sun Safety

Reuters - Innovations Video Online (Mar. 31, 2015)  The Solitair device aims to take the confusion out of how much sunlight we should expose our skin to. Small enough to be worn as a tie or hair clip, it monitors the user&apos;s sun exposure by taking into account their skin pigment, location and schedule. Matthew Stock reports.
Video provided by Reuters

Soda, Salt and Sugar: The Next Generation of Taxes

Washington Post (Mar. 30, 2015)  Denisa Livingston, a health advocate for the Dinι Community Advocacy Alliance, and the Post&apos;s Abby Phillip discuss efforts around the country to make unhealthy food choices hurt your wallet as much as your waistline.
Video provided by Washington Post

S. Leone in New Anti-Ebola Lockdown

AFP (Mar. 28, 2015)  Sierra Leone imposed a three-day nationwide lockdown Friday for the second time in six months in a bid to prevent a resurgence of the deadly Ebola virus. Duration: 01:17
Video provided by AFP

Related Stories

Dec. 11, 2014  Children with public insurance waited longer after initial evaluation for sleep-disordered breathing to undergo polysomnography (PSG, the gold standard diagnostic test) and also waited longer after ... full story

Feb. 1, 2011  Tonsillectomy is the most common major surgical procedure performed in children. Children who undergo the surgical removal of their tonsils (tonsillectomy), with or without the removal of their ... full story

Jan. 3, 2011  A multidisciplinary clinical practice guideline provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children aged 1 to 18 years under consideration ... full story

ScienceDaily features breaking news and videos about the latest discoveries in health, technology, the environment, and more -- from major news services and leading universities, scientific journals, and research organizations.